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HomeMy WebLinkAboutInsurance Certificate: Mercy Flights Inc • A O CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 12/14/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Arnie Hunter NAME: Umpqua Insurance Agency,member of Acrisure LLC (a/CNE Ext): (541)672-3348 I rA C,No): (541)673-3994 808 SE Lane E-MAIL ahunter@umpquainsurance.com ADDRESS: PO Box 730 INSURER(S)AFFORDING COVERAGE NAIC# Roseburg OR 97470 INSURERA: NATIONAL UNION FIRE INS.CO.OF PITTSBURG PA 19720G INSUREDINSURER B: STATES NATIONAL INS.CO. Mercy Flights,Inc. INSURER C: 2020 Milligan Way INSURER D: INSURER E: _ _ Medford OR 97504 INSURER F: COVERAGES CERTIFICATE NUMBER: 21/22 GL/AUTO/UMB REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 1,000,000 X Professional Liability$1 M/$3M MED EXP(Any one person) $ 10,000 A Y VFIS-TR-0025952 12/15/2021 12/15/2022 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATES 3000,000 X POLICY PRO 3,000,000 JECT LOC PRODUCTS S OTHER: Professional Liability $ 1M occ/$3M agg AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) XI ANY AUTO BODILY INJURY(Per person) $ A I OWNED SCHEDULED Y VFIS-CM-0025953 • 12/15/2021 12/15/2022 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY X AUTOS ONLY (Per accident) X Comp$500 X Coll.$1,000 $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 • A EXCESS LIAB CLAIMS-MADE VFIS-TR-0025952 12/15/2021 12/15/2022 AGGREGATE $ 20,000,000 DED X RETENTION$ 0 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ • Cyber Liability&Privacy Management Cyber Liab&Privacy Mgt $1,000,000 B 2533082 12/15/2021 12/15/2022 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) $3,000,000 Aggregate Limit Coverage A and B Combined Coverage A$1,000,000.each wrongful act and coverage B 25,000.each action for"Injunctive Relief'Additional Insured:City of Ashland,Oregon and its elected officials,officers,volunteers,agents&employees with respect to Mercy Flights activities to be performed under the contract. CERTIFICATE HOLDER CANCELLATION • SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. 20 E.Main St. AUTHORIZED REPRESENTATIVE Ashland OR 97520 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD (2) Provides us with written authorization to: (a) Obtain records and other information related to the "suit".;and (b) Conduct and control the defense of the indemnitee in such "suit". So long as the aboveconditions are met, attorneys' fees incurred by us in the defense of that indemnitee,, necessary litigation expenses incurred by us and necessary litigation expenses incurred by the indemnitee at our request will be paid as SUPPLEMENTARY PAYMENTS.-Notwithstanding the provisions of paragraph 2.b:(2) of COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY such payments will not be deemed to be damages for "bodily injury" and "property damage"and will not reduce the limits.of insurance. Our obligation to defend an insured's indemnitee and to pay for attorneys' fees and necessary litigation expenses as SUPPLEMENTARY PAYMENTS ends when: a. We have used up the applicable limit of insurance in the payment of judgments or settlements; or b. The conditions set forth above, or the terms of the agreement described in paragraph f. above, are no longer met. SECTION II. WHO IS AN INSURED 1. If you are: a. An organization other than a partnership, joint venture or limited liability company, you are an insured. b. A partnership or joint venture, you are an insured. Your members and your partners are also insureds, but only within the course and scope of your operations.. c. A limited liability company; you are an insured. Your members are also insureds, but only within the course and scope of your operations. Your managers are insureds, but Only within the course and scope of your operations. 2. In addition to you, each of the following is-an insured:- a. Volunteers and :Employees. Your 'volunteers, "employees elected or, appointed officers, directors, commissioners or trustees, but only for acts within the course and scope of their employment :by you, membership With you or authorized duties on your behalf. b. Medical Directors. Physicians who are your medical directors., but onlyfor acts within the course and scope of their medical director duties on your behalf. c. Good Samarftans. Your volunteers, "employees", elected or appointed officers, directors, commissioners'or trustees while acting as a Good Samaritan independently of hIS or her activities on your behalf, but only_when he or she encounters the scene.of an emergency requiring sudden action. In no event will such person who responds to the scene of an emergency with or for any other emergency service organization be an'insured. d. Owners of Commandeered Equipment. The owner of commandeered equipment other than an "auto" is an insured While the equipment is in your temporary care, custody or control and is being used as part of an"emergency operation". e. Real Estate Managers. Any person or any organization while acting as your real estate manager. f. Blanket Additional Insureds. ,Any person or organization required to be 'an additional insured under an "insured contract", if agreed to by you prior to.the "bodily injury"., "property damage", "personal and advertising injury"- or "medical incident", but only with respect to liability arising out of your premises or operations. VGL101 (08/03) Copyright 2002 American Alternative Insurance'Corporation. All Page 10 of 19 rights reserved. Includes copyrighted material of the Insurance GENERAL LIABILITY Services Office,Inc;with its permission. (2) Provides us with written authorization to: (a) Obtain records and other information related to the "suit"; and (b) Conduct and control the defense of-the indemnitee in such "suit". So long as the above conditions are met, attorneys' fees incurred by us in the defense of that indemnitee, necessary litigation expenses incurred by us and necessary litigation expenses incurred by the indemnitee at our request will be paid as SUPPLEMENTARY PAYMENTS. Notwithstanding the provisions of paragraph 2:b:(2) of COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY, such payments will not be deemed to be damages for "bodily injury" and "property damage"and will not reduce the limits Of insurance. Our obligation to defend an insured's indemnitee and to pay for attorneys' fees and necessary litigation expenses as SUPPLEMENTARY PAYMENTSends'When: a. We have used up the applicable limit of insurance in the payment of judgments or settlements; or b. The conditions set forth above, or the terms of the agreement described in paragraph f. above, are no longer met. SECTION II. WHO IS AN INSURED 1. If you are: a. An organization other than a partnership, joint venture or limited liability company, you are an insured. b. A partnership or joint venture, you are an insured. Your members and your partners are also insureds, but only within the course and scope of your operations. c. A limited liability company, you are an insured. Your members are also insureds, but only within the course and scope of your operations. Your managers are insureds, but only within the course and scope of your operations. 2. In addition to you,each of the following is.an insured: a. Volunteers and Employees. Your volunteers, "employees", elected or appointed officers, directors, commissioners or trustees, but only for acts within the course 'and scope of their employment by you,membership with you or authorized duties on your behalf: b. Medical Directors. Physicians who are your medical directors, but only for acts within the course and scope of their medical director duties on your behalf. C. Good Samaritans. Your volunteers, "employees", elected or appointed officers, directors, commissioners or trustees while acting as a Good:Samaritan independently of his or her,activities on your behalf, but only when he or she encounters the scene of an emergency requiring sudden action. In no event will such person who responds to the scene of an emergency with or for any other emergency service organization be an insured. d. Owners of Commandeered Equipment. The owner of commandeered equipment other than an "auto" is an insured while the equipment is in your temporary care, custody or dontrol and is being used as part of an "emergency operation". e. Real Estate Managers. Any person or any organization while acting as your real estate manager. f. Blanket Additional Insureds. Any person or organization required to be an additional insured under an "insured contract", if agreed to by you prior to the "bodily injury", "property damage'; "personal and advertising injury'', or "medical incident"; but only with respect to liability arising out of your premises or operations. VGL101 (08/03) Copyright 2002American Alternative Insurance Corporation. All Page 10 of 19 rights reserved. Includes copyrighted material of the Insurance GENERAL LIABILITY Services Office,Inc.with its permission. 3. Mobile Equipment. With respect to "mobile equipment" registered in your name under any motor vehicle registration law, any person is an insured while driving such equipment along a public highway with your permission. Any other person or organization responsible for the conduct of such person is also an insured, but only with respect to liability arising out of the operation of the equipment, and only if no other insurance of any kind is available to that person or organization for this liability. However, no person or organization is an insured with respect to "property damage"to property owned by, rented to, in the charge of or occupied by you or the employer of any person who is an insured under this provision. 4. New Organizations. Any organization you newly acquire or form, other than a partnership, joint venture or limited liability company, and over which you maintain ownership or majority interest, will qualify as a Named Insured if there is no other similar insurance available to that organization. However: a. Coverage under this provision is afforded only until the 90th day after you acquire or form the organization or the end of the policy period, whichever is earlier; b. COVERAGE A does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organization; c. COVERAGE B does not apply to "personal and advertising injury" arising out of an offense committed before you acquired or formed the organization;and d. COVERAGE C does not apply to a "medical incident" that took place before you acquired or formed the organization. No person or organization is an insured with respect to the conduct of any current or past partnership, joint venture or limited liability company that is not shown as a Named Insured in the Declarations. SECTION III. LIMITS OF INSURANCE 1. The Limits Of Insurance shown in :the Declarations and the rules below fix the most we -will pay regardless of the nurnber of: a. Insureds; b. Claims made or "suits" brought;or c. Persons or organizations making claims or bringing "suits".. 2. The General Aggregate.Limit is the most we will pay for the sum of: a. Medical expenses under COVERAGE D; -b. Damages under COVERAGE A,'except damages-because of."bodily injury" or "property damage"- included in the "products-completed,operations hazard"; c. Damages under COVERAGE B; and. d. Damages under COVERAGE C; for each Named Insured shown in the Declarations and each "location" owned by or rented to you. 3. The Products- Completed Operations Aggregate Limit is the most we will pay under COVERAGE Afor damages because of "bodily injury' and "property damage" included in the "products-completed operations hazard", for each Named.Insured shown.in the.Declarations. 4. Subject to 2. above, the Personal and Advertising Injury Limit is the most we will pay under COVERAGE B for the sum Of all damages because of all "personal and advertising injury" sustained by any person or organization. 5. Subject to 2. or 3. above, whichever applies, the Each Occurrence or Medical Incident Limit is the most we will pay for the sum Of: a. Damages under COVERAGESAand C; and b. Medical expenses under COVERAGE D; VGL101 (08/03) Copyright 2002 American Alternative Insurance Corporation. All Page 11 of 19 rights reserved. Includes copyrighted material of the Insurance GENERAL LIABILITY Services Office,Inc.with its permission. because of all "bodily injury" and "property damage" arising out of any one "occurrence" and all damages arising out of any one "medical incident". 6. Subject to 5. above, the Each Occurrence or Medical Incident Limit is the most we will pay under COVERAGE Afor damages because of"property-damage"to any one premises,while rented to you, or in the case of damage by fire, while rented to you or temporarily occupied by you with permission of the owner. 7. Subject to 5. above, the Medical Expense Limit is the most:we will pay under COVERAGE D for all medical expenses because of"bodily injury"sustained by any one person. The Limits of Insurance of this coverage part apply separately to. each consecutive annual period and to any remaining period of less than 12 months, starting with the beginning of the policy period shown in the Declarations, unless the policy period is extended after issuance for an additional period of less than 12 months. In that case, the additional period will be deemed part of the last preceding period for purposes of determining the Limits of Insurance. SECTION IV. CONDITIONS The following conditions apply in addition to the Common Policy Conditions. 1. Bankruptcy Bankruptcy or insolvency of the insured of of the insured's estate will not relieve us of.our obligations under this coverage part. 2. Duties in the Event fan Occurrence, Offense, Medical Incident,Claim;or Suit, a. You must see to it thatwe are notified as soon as practicable of an "occurrence", offense or "medical incident" which may result in a claim Or "suit". To the:extent possible, notice should include: (1) How, when and where the"occurrence", offense or "medical incident"took.place; (2) The names.and addresses of any injured persons and witnesses; and (3) The nature and location of any injury or damage arising out of the 'occurrence'', offense or "medical incident'. b. If a claim is made or "suit"is brought against any insured, you must: (1) Immediately recordthe specifics of the;claim or "suit"and the date received; and (2) Notify us as soon as practicable. You must see to it that we receive written notice of the claim or "suit"as soon as practicable. c. You and any other involved insured must (1) Immediately send us copies of any demands, notices,.summonses or legalpapersreceived in connection with the claim or "suit" (2) Authorize-us to obtain records and other information; (3) Cooperate with us in the investigation or settlement of the claim or defense-against the "suit"; and , (4) Assist us, upon our request, in the enforcement of any right against any personor organization which may be liable to the insured because of injury or damage to which this insurance may also apply. d. No insured will, except at that insured's own cost, voluntarily make a payment, assume any obligation, or incur any expense, other than for first aid, without our consent. VGL101 (08/03) Copyright 2002 American Alternative Insurance Corporation. All Page 12 of 19 rights reserved. Includes-copyrighted material of the Insurance GENERAL LIABILITY Services Offi ce, Inc.with its permission. • e. If you report an "occurrence", offense or "medical incident" to an insurer providing other than General Liability insurance, which later develops into a General Liability claim covered under this coverage part, failure to report such "occurrence", offense or "medical incident"to us at the tine of the "occurrence", offense or "medical incident" shall not be deemed in violation of these conditions. However, you shall give notification to us, as soon as is reasonably possible,that the "occurrence", offense or "medical incident" is a General Liability claim: f. Knowledge of an °occurrence", offense.or "medical incident" by any of your agents, volunteers or "employees" shall not constitute knowledge by you unless one of your officers or anyone responsible for administering your insurance program has received a notification from the agent, volunteer or "employee". 3. Legal Action Against Us No person or organization has a right under this coverage part: a. To join us as a party or otherwise bring us into a "suit"asking for damages from an insured; or b. To sue us on this coverage part unless all of its terms have been fully:complied with. A person or organization may sue us to recover on an agreed settlement or on a final judgment against an insured; but we will not be liable for damages that are not payable under the terms of this coverage part or that are in excess of the applicable limit of insurance. An agreed settlement means a settlement and release of liability signed by us, the insured and the claimant or the claimant's legal representative. 4. Other Insurance If other valid and collectible insurance is available to the insured volunteer, "employee", elected or appointed officer, director, commissioner, trustee, medical director or owner of commandeered equipment for a loss we cover under COVERAGES A, B or:C of this form, our insurance is primary, with no consideration or contribution with other insurance, except with respect to any medical malpractice liability'insurance available to a ,physician who is acting on your behalf by providing on- site medical treatment ,of a person. Wth respect to said medical malpractice liability insurance, our insurance is excess over that coverage. If-other valid and collectible insurance is available to the Insured,,:other than volunteers, `employees", elected or appointed officers, directors, commissioners, trustees, medical directors or owners of commandeered equipment, for a loss We cover under COVERAGES .A, B or C of this form; our obligations are limited as follows: ------0. a. Primary Insurance This insurance is primary except when b. below applies. If this insurance is primary, our obligations are not affected unless any of the other insurance is also primary. Then, we will share with all that other insurance by the method described in c. below. b. Excess Insurance This insurance is excess over: (1) Any of the other insurance, whether primary,excess, contingent or on any other basis (a) That is fire, extended coverage, builder's risk, installation risk or similar coverage for "your work"; (b) That is fire insurance for premises rented to you or temporarily occupied by you with permission of the owner; (c) That is insurance purchased by you to cover your liability as a tenant for "property damage" to premises rented to you or temporarily occupied by you with permission of the owner; (d) That is insurance covering your liability for "bodily injury" or "property damage" arising out of the providing, serving or selling of alcoholic beverages to others; VGL101 (08/03) Copyright 2002 American Alternative Insurance Corporation. Al Page 13 of 19 rights reserved. 'nolo des copyrighted material of the Insurance GENERAL LIABILITY Services Office,Inc.with its permission. (e) That is insurance covering your liability for "bodily injury" or "property damage" arising out of the igniting or discharging of fireworks, including but not limited to firecrackers, aerial or ground displays, in conjunction with any demonstration or show conducted or sponsored by you. However, this coverage shall not be excess should the "bodily injury" or ''property damage" result from an emergency response you provide in response to an emergency arising out of fireworks; or (f) If the loss arises out of the maintenance or use of aircraft or watercraft to the extent not subject to exclusion h. of COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY. (2) Any other primary insurance, including pools or self-insurance, covering your liability for damages arising out of the premises or operations for which you have been added as an additional insured. When this insurance is excess, we will have no duty under COVERAGES A, B or C to defend the insured against any "suit" if any other insurer has a duty to defend the insured against that "suit". If no other insurer defends, we will undertake to do so, but we will be entitled to the insured's rights against all those other insurers. When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any,thatexceeds the sum of: (a) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and (b) The total of all deductible and self-insured amounts under all that other insurance. We will share the remaining loss, if any, with any other insurance that is not described in this excess insurance provision and was not bought specifically to apply in excess of the limits of insuranceshown'in the Declarations Of this coverage part. c. Method Of Sharing If all of the other insurance permits contribution by equal shares, we will follow this method also.. Under this approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any of the other insurance ;does not permit contribution *equal shares, we will contribute by limits. Under this method, each insurer's share is based On the ratio of its applicable limit of insurance to the total applicable limits of insurance Of all insurers. 5. Representations By accepting this policy, you agree: a. The information in the Declarations is accurate and complete; b. The information is based upon representations you made to us; and C. We have issued this policy in reliance upon your representations. Your failure to disclose all hazards existing as of the inception date of the policy shall not prejudice you with respect to the coverage afforded, provided such failure Or omission is not intentional. This coverage part is void if any material fact or circumstance relating to this insurance is intentionally omitted or misrepresented. 6. Separation Of Insureds Except with respect to the Limits of Insurance, and any rights or duties specifically assigned in this coverage part to the first Named Insured,this insurance applies: a. As if each Named Insured were the only Named Insured; and b. Separately to each insured against whom claim is made or "suit" is brought, VGL101 (08/03) Copyright 2002 American Alternative Insurance Corporation. All Page 14 of 19 rights reserved. inciu des copyrighted material of the Insurance GENERAL LIABILITY Services Office,Inc.with its permission. __117. Transfer of Rights of Recovery Against Others To Us If the insured has rights to recover all or part of any payment we have made under this coverage part, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request,the insured will bring "suit or transfer those rights to us and help us enforce them. 8. When We Do Not Renew If we decide not to renew this coverage part, we will mail or deliver to the first.Named Insured shown in the Declarations written notice of the nonrenewal not less than 30 days before the expiration date. If notice is mailed, proof of mailing Will be sufficient proof of notice. SECTION V. DEFINITIONS 1. "Advertisement" means a notice that is broadcast or published to the general public or specific market segments about your goods, products or services for the purpose of attracting customers or supporters. 2. "Auto" means a land motor vehicle, trailer or semitrailer designed for travel on public roads, including any attached machinery or equipment. But "auto" does not include "mobile equipment". 3. "Bodily injury" means bodily injury, sickness or disease sustained by a person, including death resulting from any of these at any time. 4. "Coverage territory" means: a. 'The United States of America (including its territories and possessions), Puerto Rico and Canada; b. International waters or airspace, provided the injury or damage does not occur in the course.of travel or transportation to or from any place not included in:a.=above; or c. All other parts of the world if: (1) The injury or damage arises out of: (a) Goods or products made or sold by you in the territory described in a. above; or (b) The activities of a person whose home in the`territory described in a. above, but is away for a short time on your business;-and (2) The insured's responsibility to pay damages is determined in a '"suit" on the merits, in the territory described in a. above Or a settlement.we agree to. 5. "Emergency operations" means actions: a. Which are urgent responses for protection of property, human life, health or safety; and b. Which result from the performing or attempting to perform firefighting services, hazardous materials unit services, first aid, ambulance or rescue squad services, or related services, including the stabilizing or securing of an emergency scene; and c. Which are sanctioned by: (1) A fire department, hazardous materials unit, or first aid, ambulance or rescue squad qualifying as an insured under this coverage part; or (2) An officer,volunteer member or "employee' of such organization. 6. "Employee" includes a "leased worker". "Employee" does not include a "'temporary worker". 7. "Employment practices" means an actual Or alleged improper employment related practice, policy, act or omission involving an actual, prospective, or former volunteer or "employee", including: a. Failing tb hire or refusing to hire; b. Wrongful dismissal, discharge, or termination of employment or membership, whether actual or constructive; VGL101 (08/03) Copyright 2002 American Alternative Insurance Corporation. All Page 15 of 19 rights reserved, Includes copyrighted material of the Insurance GENERAL LIABILITY Services Office,Inc.with its permission. .